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1. Hepatic encephalopathy: A review

Author

Guevara L, Misael Uribe, Paloma Almeda, and Javier Lizardi-Cervera

Subjects
Male, medicine.medical_specialty, Cirrhosis, neurological alteration, Dopamine, Encephalopathy, Specialties of internal medicine, Risk Assessment, Severity of Illness Index, Gastroenterology, Pathogenesis, Liver Function Tests, Internal medicine, Severity of illness, medicine, Humans, Hepatic encephalopathy, Coma, Hepatic failure, Hepatology, medicine.diagnostic_test, Nutritional Support, business.industry, astrocytes, General Medicine, encephalopathy, Prognosis, medicine.disease, Combined Modality Therapy, Survival Analysis, Anti-Bacterial Agents, ammonium, RC581-951, Hepatic Encephalopathy, Drug Therapy, Combination, Female, medicine.symptom, Complication, business, Liver function tests, Blood Chemical Analysis
Abstract

Hepatic encephalopathy (HE) is a complication that presents in as many as 28% of patients with cirrhosis, and reported up to ten years after the diagnosis of cirrhosis. Commonly, it is observed in patients with severe hepatic failure and is characterized by neuropsychiatric manifestations that can range in severity from a mild alteration in mental state to a coma; additionally, some neuromuscular symptoms can be observed. This complication of either acute or chronic hepatic disease is the result of a diminished hepatic reservoir and inability to detoxify some toxins that originate in the bowel. Today, the role of astrocytes, specifically the Alzheimer type II cells, is known to be very important in the pathogenesis of the hepatic encephalopathy, and will be reviewed later. In conclusion, the objectives of this review are: • To understand the pathogenesis of hepatic encephalopathy  To recognize the precipitating factors, as well as preventive measures for the development of the hepatic encephalopathy  To describe the new classification of hepatic encephalopathy and its clinical implications  To recognize the clinical manifestations and stages of the disease  To understand the main diagnostic tests used to detect the hepatic encephalopathy  To describe the main therapeutic treatments of hepatic encephalopathy.

Published
2003
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2. [Untitled]

Author

Vega H, Nahum Méndez-Sánchez, Guevara L, Martha H. Ramos, Vargas-Vorackova F, and Misael Uribe

Subjects
Gerontology, medicine.medical_specialty, Physiology, business.industry, Gastroenterology, Odds ratio, Ethnic origin, Disease, medicine.disease, Obesity, Epidemiology, Medicine, Risk factor, business, Parity (mathematics), Body mass index, Demography
Abstract

According to epidemiological studies, gallstonedisease is a very common disease in Mexican-Americansand Mexicans. However, the major risk factors forcholelithiasis in Mexicans have not been identified. We designed a case-control study in a group ofMexican subjects with and without gallstone diseaseconfirmed by ultrasound. These subjects wereprospectively studied over a three-year period. Clinical and epidemiological data were collected bymeans of a questionnaire. A total of 1500 subjects wereincluded in this study: 1000 with and 500 withoutgallstone disease. The major risk factor in both men and women was body mass index [odds ratio (OR)1.64 and 1.96, respectively; P < 0.008 and 0.001]. Inaddition, parity was an important factor in women (OR2.17, P < 0.001), whereas age was associated withgallstone disease in men (OR 1.43, P < 0.001). Wefound that body mass index, parity, and age were theprincipal risk factors for gallstone disease in thisgroup of Mexican subjects. These results are similar tothose found in Mexican-Americanpopulations.

Published
1998
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3. Beneficial Effect of Carbohydrate Maldigestion Induced by a Disaccharidase Inhibitor (AO-128) in the Treatment of Chronic Portal-Systemic Encephalopathy: A Double-Blind, Randomized, Controlled Trial

Author

J.L. Poo, G García-Ramos, Misael Uribe, Guevara L, Segundo Moran, and Nahum Méndez-Sánchez

Subjects
Male, medicine.medical_specialty, Malabsorption, Lactitol, Encephalopathy, Disaccharidases, Disaccharides, Gastroenterology, Intestinal absorption, Lactulose, chemistry.chemical_compound, Double-Blind Method, Internal medicine, medicine, Humans, Enzyme Inhibitors, Hepatic encephalopathy, business.industry, Middle Aged, Carbohydrate, Cyclohexanols, medicine.disease, Disaccharidase, Endocrinology, Intestinal Absorption, chemistry, Hepatic Encephalopathy, Female, business, medicine.drug
Abstract

The most widely used treatment of portal-systemic encephalopathy (PSE) is the administration of oral, non-absorbable disaccharides. Theoretically, the inhibition of intestinal disaccharidases should induce malabsorption of disaccharides and increase delivery of undigested carbohydrates to the colon, thus stimulating the effects of lactulose and other non-absorbable disaccharides (that is, lactitol and lactose). AO-128 is an N-substituted derivative of valeolamine, an aminocyclitol that selectively inhibits intestinal disaccharidases. This study was performed to investigate whether AO-128 could be used as adjuvant therapy for the treatment of mild PSE in cirrhotic patients.A double-blind, randomized, controlled trial was performed in 35 cirrhotic patients with PSE. Patients were given a 2-week treatment consisting of AO-128 (2 mg three times daily) or an identical placebo. The following features of PSE syndrome were assessed in a semiquantitative fashion before and after I and 2 weeks of therapy: mental state, asterixis, number connection test (NCT), venous blood ammonia concentration, electroencephalogram (EEG), and overall PSE index (PSEI). More patients receiving AO-128 than patients receiving placebo showed40% improvement in the PSEI (83% versus 35%; P0.05). The mean stool pH decreased from 5.8+/-0.3 to 5.5+/-0.3 (P0.004) after AO-128 treatment, whereas no changes were observed in the placebo group. The EEG and nitrogen balance did not show significant changes in any of the two groups. A significant improvement was seen in the NCT performance after AO-128 (from grade 2.0+/-1.04 to grade 1.25+/-0.87; P0.05). Seven patients treated with AO-128 developed diarrhea, as compared with none in the placebo group (P0.05).These results suggest that AO-128 may be useful in the treatment of PSE, although further studies are required to establish the benefit of AO-128 and determine adequate individual doses.

Published
1998
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4. Cardiorenal End Points in a Trial of Aliskiren for Type 2 Diabetes

Author

Parving, Hh, Brenner, Bm, Mcmurray, Jj, de Zeeuw, D, Haffner, Sm, Solomon, Sd, Chaturvedi, N, Persson, F, Desai, As, Nicolaides, M, Richard, A, Xiang, Z, Brunel, P, Pfeffer, Ma, Viberti, G, Lachin, Jm, Zinman, B, Pedersen, Tr, Villamil, As, Juncos, L, Prager, R, Verpooten, G, Zanella, Mt, Leiter, L, Pan, C, Wang, H, Botero, R, Cifkova, R, Christiansen, Js, Groop, Ph, Marre, M, Haller, H, Nickenig, G, Siamopoulos, K, Gero, L, Maggioni, A, Remuzzi, G, Katayama, Ss, Kim, Sg, Petrulioniene, Z, Lok, D, Kooy, A, Jorde, R, Medina, F, Polonia, J, Wong, Ks, Dukat, A, Rayner, Bl, Ruilope, L, Weiss, L, Wuethrich, R, Sheu, W, Sritara, P, Comlekci, A, Bilous, R, Toto, R, Jamerson, K, Carillo, E, Orias, M, Kuschnir, E, Rusculleda, M, Garcia, S, Farias, E, Lema, L, Hominal, M, Montaña, O, Sala, J, Diaz, M, Piskorz, D, Vita, N, Litwak, L, Sinay, I, Marin, M, Massari, P, Majul, C, Aizemberg, D, Azize, Gm, Bartolacci, I, Reboredo, A, Vico, M, Milesi, R, Sessa, H, Wassermann, A, Margulis, F, Zangroniz, P, Watschinger, B, Toplak, H, Paulweber, B, Drexel, H, Francesconi, C, Foeger, B, Mayer, G, Braun, Rk, Brath, H, Gaal, Lv, Niepen, Pv, Persu, A, Vercammen, C, Vriese, Ad, Coucke, F, Mathieu, C, Fery, F, Treille, S, Meeus, G, Acker, Kv, Scheen, A, Tits, J, Ruige, J, Krzesinski, Jm, Hollanders, G, Liénart, F, Dendale, P, Quinonez, M, Arnouts, P, Vanuytsel, J, Zanella, M, Mion D., Jr, Forti, A, Almeida, F, Cunha, R, de Paula RB, Brandao, A, Rocha, J, Krieger, E, Feitosa, G, Saraiva, J, Martin, J, Hissa, Mn, Schmid, H, Felicio, J, Sgarbi, J, Oigman, W, Bowering, K, Garceau, C, Berlingieri, Jc, Weisnagel, Sj, Hardin, P, Powell, C, Turcot, R, Muirhead, N, Aronson, R, Barima, Yt, Steele, Aw, Pandey, S, Woo, V, Cha, J, Dattani, D, Godin, C, Gupta, M, Saunders, K, Tellier, G, Ting, R, Tobe, S, Chouinard, G, Schlosser, R, Khandwala, H, Ekoe, Jm, Harris, Sb, Pichette, V, Lachance, P, Ooi, Tc, Tildesley, H, Barrett, B, Cournoyer, S, Lu, J, Zhang, H, Liu, X, Yan, S, Qi, X, Li, Q, Li, H, Lv, X, Yang, J, Sun, N, Xia, W, Wang, N, Tong, N, Mei, C, Gu, S, Zhang, J, Chen, X, Li, L, Su, B, Wang, L, Qiu, M, Wu, X, Liu, Z, Jia, W, Xu, G, Dong, J, Zhu, D, Zhang, M, Yan, J, Liu, B, Chen, J, Fu, J, Yan, L, Zhan, X, Zhong, L, Yang, T, Ma, J, Xu, M, Xu, X, Shi, B, Ji, Q, Zhong, H, He, R, Yuan, Z, Zhou, Z, Lin, H, Yang, W, Ke, Y, Hong, T, Franco, C, Casas, L, Triana, A, Jaramillo, C, Hernandez, E, Barrera, C, Blanco, D, Stipal, R, Widimsky, P, Dohnalova, L, Komroskova, M, Kvapil, M, Belobradkova, J, Tesar, V, Vodnansky, P, Kocourkova, B, Lervang, Hh, Perrild, H, Rossing, P, Oestergaard, O, Juhl, H, Thorsteinsson, B, Snorgaard, O, Urhammer, S, Egstrup, K, Tikkanen, T, Helin, K, Rinne, J, Lahtela, J, Strand, J, Valtonen, E, Saari, M, Kananen, K, Savela, K, Blacher, J, Aldigier, Jc, Zaoui, P, Fauvel, Jp, Gouet, D, Valensi, Pe, Charpentier, G, Marechaud, R, Penfornis, A, Ovize, M, Kovalchuck, Aa, Dellanna, F, Schoen, N, Groeschel, W, Eickhoff, F, Hanefeld, M, Merke, J, Rambausek, M, Zimmermann, U, Stuetz, W, Vosskuehler, A, Hevendehl, G, Schax, U, Lehmann, G, Haack, A, Hilgenberg, J, Klausmann, G, Adelberger, V, Gessner, S, Fiesselmann, A, Oerter, E, Hohenstatt, T, Groeschel, A, Behnke, T, Sisting, Rt, Schoch, D, Bieler, T, Schleyer, S, Altes, U, Klepzig, C, Rudofsky, G, Mueller, G, Burkhardt, F, Reschke, K, Senftleber, I, Wiesweg, Ck, Herrmann, Hj, Brandstetter, R, Segner, A, Schmitt, H, Rippert, R, Goebel, R, Schreibmueller, F, Pencz, I, Ott, P, Migdalis, I, Pappas, S, Pagkalos, E, Yalouris, A, Tsapas, A, Maltezos, E, Tentolouris, N, Papadakis, I, Ioannidis, G, Goumenos, D, Corona, V, Gonzalez, R, Haase, F, Monterroso, V, Sánchez, V, Turcios, E, Wyss, F, Arango, Jl, Bako, B, Deak, L, Dömötör, E, Dudas, M, Fulop, T, Kiss, I, Koranyi, L, Lengyel, Z, Nyirati, G, Oroszlan, T, Aniko, S, Vörös, P, Kapocsi, J, Wittmann, I, Paragh, G, Abraham, G, Tandon, N, Thomas, N, Mohan, V, Sahay, R, Sethi, B, Rao, V, Kumar, S, Chowdhury, S, Dharmalingam, M, Seshiah, V, Bantwal, G, Viswanathan, V, Yajnik, C, Adhikari, P, Krishnan, U, Varthakavi, P, Hiremath, J, Bhattacharyya, A, Dani, S, Modi, Kk, Glorioso, N, Morosetti, M, Veglio, Franco, Perticone, F, Dotta, F, Quarello, F, Sesti, G, Aiello, A, D'Ospina, A, Giordano, C, Novo, S, Santoro, A, Ferri, C, Capuano, V, Trimarco, B, Tonolo, G, Villa, G, De Pellegrin, A, Zanette, G, Federici, M, Aucello, G, Piatti, P, Vinciguerra, A, Mannarino, E, Taddei, S, Filetti, S, Grandaliano, G, Marchionni, N, Lambiase, C, Locatelli, F, Scanferla, F, Lembo, G, Leotta, S, Mos, L, Calatola, P, Fogari, R, David, S, Pedrinelli, R, Pignone, Am, Cozzolino, D, Bevilacqua, Mt, Catena, C, Del Prato, S, Cerasola, G, Frontoni, S, Falcone, C, Porta, A, Bonora, E, Cocchi, R, Fucili, A, Frisinghelli, A, Volpe, M, Carugo, S, Gambardella, S, Spagnuolo, V, Maglia, G, D'Angelo, Ar, Corsi, A, Limone, Pp, Guarnieri, A, Ghigo, Ezio, Ronchi, E, Ravera, M, Scioli, Ga, Sekiguchi, M, Aoki, S, Ogawa, Y, Seino, H, Onishi, Y, Tojo, A, Narimiya, M, Iwaita, Y, Takeda, H, Shimizu, H, Yamada, T, Kojima, S, Zushi, S, Kaneko, S, Matsumoto, A, Kajiyama, S, Fujita, H, Shikata, K, Tone, A, Matsubayashi, S, Tanaka, S, Sekigami, T, Tatsukawa, Y, Abe, N, Kawahara, K, Kasahara, H, Maeda, Y, Suzuki, Y, Okamoto, H, Tachi, K, Yamada, K, Uzu, T, Itou, T, Fukui, T, Kim, S, Kim, Y, Cho, W, Kwak, I, Chae, D, Oh, H, Ha, S, Shin, Y, Cha, D, Kang, S, Lim, C, Song, J, Kwon, Y, Badariene, J, Labutiniene, Ip, Zabuliene, L, Poteliuniene, V, Miglinas, M, van den Meiracker AH, Gregoor, Pj, Luik, Aj, van Loon BJ, Feenstra, Hj, Kaasjager, Ha, Viergever, Pp, Woittiez, Aj, van Bemmel, T, Lieverse, Ag, Simsek, S, Gaillard, Ca, van der Zwaan, C, Lok, Dj, Spiering, W, Nierop, Pr, Baggen, Mg, Leendert, Rj, de Jong, A, Leurs, Pb, Vincent, Hh, Wins, Eh, Voors, Aa, Ronner, E, Heeg, Je, van Hal JM, Boermans, T, Feis, Wl, Mostard, G, Bakker, Rc, Dunselman, Ph, Skeie, S, Istad, H, Skjelvan, G, Gronert, J, Tomala, T, Gudnason, S, Torvik, Dt, Risberg, K, Abedini, S, Cabrera, W, Medina, B, Herrada, B, Saavedra, A, Polonia, Dj, Providencia, Dl, Carvalho, D, Vasconcelos, Mp, da Silva GF, Branco, P, Gil, Dv, da Costa AG, da Silva PM, Arez, L, Martins, L, Birne, R, Dzuponova, J, Surovcikova, M, Culak, J, Filipova, S, Andre, I, Stevlik, J, Uhliar, R, Fabryova, L, Benacka, J, Koleny, D, Szentivanyi, M, Spisak, V, Pella, D, Pastrnakova, E, Martinka, E, Chua, T, Lau, T, Ng, Tg, Yeoh, Ly, Bhana, Sa, Rayner, B, Wellmann, H, Amod, A, Ranjith, N, Ahmed, F, Rheeder, P, Makan, H, Naicker, P, Podgorski, G, De Teresa, E, Olivan, J, Fernandez, Vl, Povedano, St, Terns, M, Ricart, W, Gonzalez, Jm, Fernandez, P, Parreño Lde, T, Redon, J, Parra, J, Calvo, C, Lopez, I, Puig, Jg, Calle, A, Garcia, Jc, Lopez, Jm, Jimenez, Ml, Fraile, B, Perez, Js, Nadal, Jj, Guija, E, Calviño, J, Barrios, V, Iglesias, Jn, Armario, P, Garcia, M, Aranda, P, Brotons, C, Gomez, P, Catelao, Am, Cusachs, Ar, Sarro, M, Martinez, V, dell Valle MH, Trias, F, Comas, A, Salvador, N, Martinez, F, Hernandez, F, Martinez, J, Mateos, C, Peral, Jl, Tolosana, J, Sobrino, J, Isart, J, Vizcaino, J, Vega, Ff, Zamorano, Jl, Bacariza, M, Soubriet, A, Fernández Cruz, A, Querejeta, R, Leira, Vm, Iglesias, Fe, Ibrik, O, Martin, D, Nanclares, Ms, Mediavilla, Jd, Galceran, Jm, Lopez, A, Muros, T, Pascual, J, Casalla, F, Tornero, F, Fernandez, G, Pettersson, P, Olsen, H, Franke, F, Stroembom, U, Furuland, H, Larnefelt, H, Allemann, Y, Krapf, R, Gerber, P, Munger, R, Hayoz, D, Graf, Hj, Burnier, M, Petrillo, A, Batt, R, Constam, En, Moccetti, T, Bianda, T, Rickli, H, Bulliard, C, Wu, Kd, Lin, Sh, Wu, Cj, Sheu, Wh, Su, Sl, Chen, Sc, Chou, Cw, Lee, Ct, Yang, Tc, Chen, Hc, Sukonthasarn, A, Sriratanasathavorn, C, Eiam Ong, S, Supasyndh, O, Chanchairujira, T, Kitiyakara, C, Arici, M, Usalan, C, Guneri, S, Koc, M, Kalender, B, Ates, K, Gurgun, C, Araz, M, Demirbas, B, Biernacki, W, Calvert, J, Eavis, P, Kerrane, J, Litchfield, J, Middleton, A, Roberts, J, Simpson, H, Charles, H, Jardine, A, Fisher, M, Banerjee, D, Gallen, I, Gnudi, L, Harvey, J, O'Hare, P, Vora, J, Winocour, P, Soran, H, Browne, D, Darko, D, Mancebo, Jg, de Roa ER, Antepara, N, Carrillo, E, Berrizbeitia, M, Guevara, L, Pernalete, N, Ontiveros, C, Zigrang, W, Blakney, E, Rosenblit, P, Weinstein, R, Klaff, L, Lipetz, R, Busick, E, Tung, P, Cooperman, M, Michael, S, Sun, Ch, Hart, T, Maddux, A, Bowden, R, East, C, Arakaki, R, Villafuerte, B, Mamish, Z, Mendez, R, Connery, L, Nour, K, Wynne, A, Busch, R, Zamora, B, Sachson, R, Prasad, J, Lasala, G, Smith, M, Fitz Patrick, D, Ruiz Rivera, L, Barranco, E, Solomon, R, Woolley, A, Brown, C, Freedman, Z, Schmidt, S, Pollock, J, Ruddy, M, Kopyt, Np, Bazzi, A, Horowitz, B, Feng, W, Wahl, T, Duprez, D, Gilbert, J, Steigerwalt, S, Jacqmein, J, Gorton, S, 3rd, Allison J., Pino, J, Lock, J, Leimbach, W, Anderson, J, Beacom, M, Craig, W, Gorson, D, Kerstein, H, Segal, S, Downey, H, Ledger, G, Mcgill, J, Gabriel, J, Nolen, T, Levinson, L, Williams, T, Levenson, D, Lerman, S, Minehart, C, Agarwal, N, Verma, S, Valitutto, M, Demetry, K, Mersey, J, Koeper, D, Fanti, P, Eng, G, Grimm, R, Fagan, T, Bajaj, M, Katz, L, Portnay, G, Altschuller, A, Desai, V, Bilazarian, S, Ipp, E, Rodelas, R, Burstein, D, Berg, J, Velez, J, Lund, R, Rekhi, A, Martin, E, Robertson, D, Singh, N, Narayan, P, Moustafa, M, Lanier, D, Seidner, M, Phillips, A, Vaughters, B, Sprague, A, Swartz, S, Lopez, R, Kumar, J, Bressler, P, Sadler, L, Wise, J, Kilbane, A., and Groningen Kidney Center (GKC)

Subjects
Male, Hyperkalemia, CARDIOVASCULAR MORTALITY, BLOOD-PRESSURE, Angiotensin-Converting Enzyme Inhibitors, Type 2 diabetes, GLOMERULAR-FILTRATION-RATE, DOUBLE-BLIND, chemistry.chemical_compound, Fumarates, cardiovascular disease, Renin, Treatment Failure, Settore MED/49 - Scienze Tecniche Dietetiche Applicate, 610 Medicine & health, diabetes, Medicine (all), Hazard ratio, aliskiren, diabete, trial clinico, Liter, General Medicine, Middle Aged, hypertension, Cardiovascular Diseases, Combination, HEART-FAILURE, Drug Therapy, Combination, Female, Kidney Diseases, type 2 diabetes, medicine.symptom, Type 2, medicine.medical_specialty, Patient Dropouts, Urology, Hypokalemia, Aliskiren, chronic kidney disease, Placebo, Angiotensin Receptor Antagonists, LEFT-VENTRICULAR DYSFUNCTION, Drug Therapy, Double-Blind Method, Diabetes Mellitus, medicine, Humans, CONVERTING-ENZYME INHIBITORS, Antihypertensive Agents, Aged, Amides, Diabetes Mellitus, Type 2, Follow-Up Studies, business.industry, medicine.disease, Confidence interval, Surgery, Blood pressure, MYOCARDIAL-INFARCTION, chemistry, SYSTOLIC DYSFUNCTION, FOLLOW-UP, business
Abstract

BACKGROUND This study was undertaken to determine whether use of the direct renin inhibitor aliskiren would reduce cardiovascular and renal events in patients with type 2 diabetes and chronic kidney disease, cardiovascular disease, or both. METHODS In a double-blind fashion, we randomly assigned 8561 patients to aliskiren (300 mg daily) or placebo as an adjunct to an angiotensin-converting-enzyme inhibitor or an angiotensin-receptor blocker. The primary end point was a composite of the time to cardiovascular death or a first occurrence of cardiac arrest with resuscitation; nonfatal myocardial infarction; nonfatal stroke; unplanned hospitalization for heart failure; end-stage renal disease, death attributable to kidney failure, or the need for renal-replacement therapy with no dialysis or transplantation available or initiated; or doubling of the baseline serum creatinine level. RESULTS The trial was stopped prematurely after the second interim efficacy analysis. After a median follow-up of 32.9 months, the primary end point had occurred in 783 patients (18.3%) assigned to aliskiren as compared with 732 (17.1%) assigned to placebo (hazard ratio, 1.08; 95% confidence interval [CI], 0.98 to 1.20; P = 0.12). Effects on secondary renal end points were similar. Systolic and diastolic blood pressures were lower with aliskiren (between-group differences, 1.3 and 0.6 mm Hg, respectively) and the mean reduction in the urinary albumin-to-creatinine ratio was greater (between-group difference, 14 percentage points; 95% CI, 11 to 17). The proportion of patients with hyperkalemia (serum potassium level, = 6 mmol per liter) was significantly higher in the aliskiren group than in the placebo group (11.2% vs. 7.2%), as was the proportion with reported hypotension (12.1% vs. 8.3%) (P CONCLUSIONS The addition of aliskiren to standard therapy with renin-angiotensin system blockade in patients with type 2 diabetes who are at high risk for cardiovascular and renal events is not supported by these data and may even be harmful. (Funded by Novartis; ALTITUDE ClinicalTrials.gov number, NCT00549757.)

Published
2012
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5. Role of the distal splenorenal shunt in management of variceal bleeding in Latin America

Author

Takeshi Takahashi, Jorge Ortiz, Guadalupe Garcia-Tsao, Miguel Angel Mercado, Héctor Orozco, Manuel Tielve, Guevara L, and Armando Hernández-Cendejas

Subjects
Adult, Male, medicine.medical_specialty, Variceal bleeding, Cirrhosis, Adolescent, Encephalopathy, Esophageal and Gastric Varices, Postoperative Complications, Humans, Medicine, Child, Aged, Retrospective Studies, Distal splenorenal shunt, business.industry, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Thrombosis, Surgery, Portal hypertension, Female, Emergencies, Gastrointestinal Hemorrhage, business, Splenorenal Shunt, Surgical, Shunt (electrical)
Abstract

In the early 1970s, we began to perform selective shunts on a regular basis for the treatment of portal hypertension. In a 15-year period, 177 patients (155 with liver cirrhosis) were treated with 3 kinds of selective shunts: the Warrent shunt (128 patients) the end-to-end splenorenal shunt (29 patients), and the splenocaval shunt (20 patients). One hundred sixty-seven of the procedures were elective. Operative mortality was 14%, and survival for the Child's class A group was 75% at 1 year, 69% at 5 years, and 65% at 15 years. Incapacitating encephalopathy was observed in 7% of the patients, rebleeding in 6%, and shunt thrombosis in 6%. Postoperative portal vein alterations included reduced venous diameter (13%) and thrombosis (21%). Experience with the Warren shunt in schistosomiasis, a disease in which normal liver function is the rule in Latin American countries, is discussed. We believe that, when feasible, the selective shunts are the treatment of choice for portal hypertension in Latin American countries.

Published
1990
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6. Lactitol, a second-generation disaccharide for treatment of chronic portal-systemic encephalopathy

Author

Heloisa Toledo, Gian-Paolo Ravelli, Franz Perez, Guevara L, Guillermo García-Ramos, Misael Uribe, Florencia Vargas, and Sofia Gil

Subjects
Male, medicine.medical_specialty, Randomization, Cirrhosis, Lactitol, Physiology, Encephalopathy, Lactose, Gastroenterology, law.invention, Random Allocation, chemistry.chemical_compound, Sugar Alcohols, Double-Blind Method, Randomized controlled trial, law, Internal medicine, medicine, Humans, Clinical Trials as Topic, business.industry, Hepatobiliary disease, Middle Aged, medicine.disease, Crossover study, Surgery, chemistry, Hepatic Encephalopathy, Female, business
Abstract

A double-blind crossover trial was performed to test the therapeutic usefulness and safety of lactitol, a beta-galactoside sorbitol, against lactose in 18 patients with chronic portal-systemic encephalopathy (PSE). The study included four periods: two for washout and two for lactitol and lactose administration. During washout periods, which lasted two weeks each, patients were stabilized with neomycin plus milk of magnesia. Lactitol and lactose were administered during four weeks each. Ten patients were randomly assigned to receive lactose (group A) and eight patients to receive lactitol (group B) first. PSE parameters, ie, mental state, number connection test performance, asterixis and blood ammonia levels were assessed fortnightly. Electroencephalographic tracings and stool pHs were evaluated at the end of each study period. After the first administration of lactose and lactitol, no statistically significant differences in PSE parameters were found. At the same stage, a significant stool acidification (P less than 0.05) was detected. It is concluded that lactitol seems to be safe and efficacious in treating patients with chronic PSE.

Published
1987
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7. Survival and quality of life after selective portasystemic shunts

Author

Misael Uribe, Guevara L, Javier Elizondo, Campuzano M, Héctor Orozco, Juan-Ramón Aguilar, and Jorge Hernández-Ortiz

Subjects
Adult, Liver Cirrhosis, Male, Variceal bleeding, medicine.medical_specialty, Adolescent, Encephalopathy, Hospital mortality, medicine, Humans, Portasystemic Shunt, Surgical, Survival rate, Aged, Distal splenorenal shunt, business.industry, Surgical mortality, General Medicine, Middle Aged, Prognosis, medicine.disease, Surgery, Quality of Life, Female, business, Shunt (electrical)
Abstract

Selective portasystemic shunts were performed in 55 consecutive patients; 27 underwent end-to-end selective renosplenic shunt, 18 distal splenorenal shunt and 10 splenocaval shunt. Thirty-one patients were in Child's class A, 18 were in class B and 6 in class C. Hospital mortality for the whole group was 16 percent and occurred less frequently in class A than in class B and C patients. Five year predicted survival for the whole group was 59 percent. At the same period of follow-up, class A patients had a higher survival rate than those in class B and C (83 percent versus 36 percent; p < 0.01). No striking difference in 5 year survival was evident in alcoholics and nonalcoholics (52 percent versus 61 percent). After surgery, long-term portasystemic encephalopathy and bleeding were noted in 2 of 36 survivors. For class A patients, selective portal shunts offer an adequate and relative safe method for decreasing mortality due to variceal bleeding.

Published
1981
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8. Treatment of chronic portal systemic encephalopathy with bromocriptine

Author

M. A. Marquez, Guevara L, Misael Uribe, G Garcĭa-Ramos, and A Farca

Subjects
Constipation, Hepatology, business.industry, Standard treatment, Gastroenterology, Cathartic, Placebo, Bromocriptine, law.invention, Clinical trial, Randomized controlled trial, law, Anesthesia, Medicine, medicine.symptom, business, medicine.drug, Asterixis
Abstract

A randomized double-blind clinical comparison of bromocriptine, a new dopamine agonist, and placebo was performed on 7 cirrhotic patients with chronic portal systemic encephalopathy (PSE). Before given either medication, patients were stabilized with a standard treatment (neomycin and cathartics). Serial semiquantitative assessments were done, including mental state, asterixis, number connection test, electroencephalogram, and ammonia blood levels. Three patients developed signs of precoma while ingesting both placebo and bromocriptine. Two patients experienced precoma only with placebo, and another patient only while taking bromocriptine. One patient remained awake throughout the study. All patients responded initially to neomycin and cathartics. Bromocriptine proved not to be significantly superior to placebo and was always inferior to standard treatment. During treatment with bromocriptine, 3 patients experienced constipation. This may be partially responsible for the ineffectiveness in the treatment of PSE.

Published
1979
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9. Deficiency of protein C in patients with portal vein thrombosis

Author

Guevara L, Rafael Hurtado, Jorge Hernández-Ortiz, Marco A. Casillas, Roger Anaya, Guadalupe Garcia-Tsao, Hector Orozco, Guillermo J. Ruiz-Argüelles, Edmundo Guraieb, and Takeshi Takahashi

Subjects
Adult, Male, medicine.medical_specialty, Sugiura procedure, Mesenteric Veins, Protein C deficiency, Recurrence, Hypertension, Portal, Mesenteric Vascular Occlusion, medicine, Humans, Hepatology, medicine.diagnostic_test, business.industry, Portal Vein, Protein C Deficiency, Thrombosis, Middle Aged, medicine.disease, Surgery, Portal vein thrombosis, Liver biopsy, Portal hypertension, Upper gastrointestinal bleeding, Varices, business, Gastrointestinal Hemorrhage, Protein C
Abstract

Portal vein thrombosis has been considered idiopathic in 50% of cases reported in adults. Protein C deficiency is a recently described disorder characterized by a predisposition to develop thromboembolic disease. We report the findings in two patients with portal hypertension and bleeding varices due to portal vein thrombosis in whom a deficiency of protein C was present. Both cases were very similar, with a history of recurrent episodes of systemic thromboembolic disease, mesenteric venous thrombosis that required intestinal resection and upper gastrointestinal bleeding from gastroesophageal varices. Portal hypertension as well as portal vein thrombosis were demonstrated. The hematologic work-up revealed a deficiency of protein C. Both patients were subjected to the Sugiura procedure, and anticoagulation was instituted thereafter. At the time of surgery, a liver biopsy was performed, which was reported as “normal.” Two years and 3 months, respectively, after surgery both patients are in good condition. We conclude that protein C deficiency should be investigated in all cases of portal vein thrombosis, especially in those with a history of thromboembolic disease elsewhere.

Published
1988

10. AGATA-Advanced GAmma Tracking Array

Author

A. Colombo, Y. Mariette, A. Johnson, W. Korten, A. Brondi, T. Faul, J. Robin, R. Depalo, M. Slee, J. Gre¸bosz, H. C. Boston, H. Harroch, B. Rossé, M. Filliger, M. Gulmini, A. Korichi, S. Brambilla, J.R. Cresswell, C. Parisel, P. Edelbruck, F. Ameil, F. Camera, C. Oziol, Matthew Richard Dimmock, G. Salvato, F. Morbiducci, J. Ropert, M. Borsato, E. Legay, Marco Bellato, C. Santos, Gheorghe Pascovici, L. Charles, J. Pancin, G. Casati, P. G. Bizzeti, T. Stanios, S. Lhenoret, Diego Barrientos, P.M. Jones, Andreas Görgen, V. Chambert, S. Aydin, K. Hauschild, B. Hervieu, R. Nicolini, J. Simpson, H. J. Wollersheim, L. Lavergne, Pär-Anders Söderström, G. S. Simpson, G. Jaworski, F. Filmer, R. Griffiths, P.S. Morrall, M. Petcu, G. Lo Bianco, D. Linget, A. Givechev, D. C. Oxley, M. Kogimtzis, F. Salomon, J. Jolie, D. Wells, S. Moon, C. Aufranc, A. Corsi, T. Descombes, N. Goel, J. Thornhill, N. Warr, Serkan Akkoyun, B. Birkenbach, F. Dorangeville, Joël Chavas, P. Medina, Roberto Isocrate, C. Weber, E. Merchan, Bo Cederwall, I. Kojouharov, Enrique Sanchis, A. Lopez-Martens, Oliver Wieland, F. Le Blanc, D. Seddon, S. C. Letts, D. Bazzacco, J. Leske, B. Bruyneel, Alberto Pullia, L. Nelson, G. La Rana, B. Travers, I. Burrows, G. Maron, S. Coelli, J. J. Valiente-Dobón, F. Saillant, Piotr Bednarczyk, V.L. Ngo, J. Mierzejewski, Norbert Pietralla, R.S. Kempley, N. Kurz, M. Rebeschini, S. Fantinel, D. L. Balabanski, A. J. Boston, F. Tomasi, R. Berthier, M. D. Salsac, B. Dulny, C. Stahl, N. Dosme, C. Fanin, R. Baumann, S. Pietri, A. Astier, M. Nicoletto, J. van der Marel, A. Bracco, Björn Jonson, D. Mengoni, D. Bloor, Luna Pellegri, F. Lefebvre, D. Pugnére, J. Egea, S. Cabaret, D. Curien, M. Reese, C. Commeaux, Dirk Rudolph, A. Giannatiempo, F. Recchia, L. Ramina, A. Lermitage, C. A. Ur, R. M. Lieder, I.P. Brawn, R. Menegazzo, R. Raine, Krasimir Mitev, D. R. Napoli, G. Suliman, M. Kebbiri, Y. Drouen, Susan Rigby, W. Me¸czyński, R. Wadsworth, F. Didierjean, P. Desesquelles, Ch. Veyssiere, S. Leoni, Vicente González, P. Gros, Y. Le Noa, M. Castoldi, O. Möller, R. Orlandi, Thomas Beck, M. Şenyiğit, A. Jungclaus, L. Gibelin, Mohammed Kaci, Zs. Podolyák, J. Gerl, S. Erturk, W. Gast, B. Melon, V. Mendéz, R. Peghin, P. Molini, M. N. Erduran, D. Conventi, Pankaj S. Joshi, E. Clément, F.A. Beck, A. Austin, A. Cortesi, J. Palin, P. Cocconi, L. J. Harkness, F. C. L. Crespi, Dirk Weisshaar, P. Sona, A. Czermak, D. Lersch, N. Blasi, Anton Khaplanov, O. Stezowski, B. Rubio, R. Venturelli, M.-H. Sigward, E. Viscione, José Salt, C. S. Özben, Giancarlo Ripamonti, P. Spolaore, Johan Nyberg, S. M. Lenzi, L. Legeard, N. Redon, C. Rossi Alvarez, C. He, R. Chapman, P. Le Pouhalec, C. Diarra, Herbert Hess, T. Engert, A. Kaşkaş, Stanislav Tashenov, S. Klupp, C. Michelagnoli, Elif Ince, A. Algora, J. F. Smith, M. Ozille, Alessandro Zucchiatti, Angelo Geraci, A. Olariu, M. Labiche, N. Karkour, Stefano Riboldi, P. Bourgault, C. M. Petrache, M. Palacz, M. El Chambit, J.-L. Cercus, M. Zie¸bliński, Alex Wiens, R. Beunard, X. Lafay, T. Habermann, M. Karolak, L. Costa, Y. Aubert, Begoña Quintana, A P Robinson, V. F. E. Pucknell, D. Rosso, A. Capsoni, Emanuele Vardaci, L. Mihailescu, M. Tripon, E. Farnea, Ch. Theisen, Enrico Calore, G. Duchêne, N. V. Zamfir, X. Grave, S. Lunardi, I.H. Lazarus, José Blasco, D. Montanari, J.A. Sampson, P. H. Regan, N. Marginean, M. Pignanelli, L. Arnold, G. Benzoni, R. Krücken, G. de Angelis, D.P. Scraggs, I. Piqueras, D. M. Cullen, A. Obertelli, A. Bürger, D. Bortolato, G. Rainovski, A.R. Mather, P. Reiter, C. Unsworth, G. Baulieu, P. J. Coleman-Smith, C. Boiano, M. Richer, Sébastien Perrier, Agnese Giaz, Reynold J. Cooper, V. Vandone, S. Tanguy, C. Domingo-Pardo, A. Bouty, A. N. Grint, A. Maj, A. Gottardo, L. Berti, E. Pachoud, R. Marginean, E. A. Stefanova, A. Triossi, M. Nespolo, D. Bucurescu, R. Moro, H.T.M. Ha, D. S. Judson, J. L. Tain, A. Perego, Francesco Lelli, P. Detistov, B.Y. Ky, J. Ljungvall, B. Sowicki, M. Schlarb, F. Azaiez, P. Pariset, Ertan Şahin, R. Gernhäuser, M. Turcato, John Paul Strachan, B. Million, A. Atac, F. Carrio, D. Delbourg, F. Veronese, Th. Kröll, B. Cahan, A. Hernandez-Prieto, M. A. Bentley, K.M.M. Tun-Lanoë, B. Alikhani, P. Boutachkov, S. Leboutelier, Maria Doncel, A. M. Bizzeti-Sona, R. Touzery, A. Nannini, A. Lotode, P. J. Nolan, G. Rampazzo, F. Zocca, H. Schaffner, J. Eberth, A. Gadea, N. Toniolo, T. Hüyük, Q.T. Doan, P. Petkov, S. Broussard, S. Badoer, M. Rigato, Philip M Walker, J. Pouthas, Ch. Finck, L. Milechina, M. Norman, E. Pierre, J. Roccaz, S.J. Colosimo, Lázaro Guevara, Glyn Wittwer, Millan, Vicente Gonzalez -- 0000-0001-6014-2586, Rainovski, Georgi -- 0000-0002-1729-0249, Jaworski, Grzegorz -- 0000-0003-2241-0329, KORTEN, Wolfram -- 0000-0002-3940-0816, Domingo-Pardo, Cesar -- 0000-0002-2915-5466, Triossi, Andrea -- 0000-0001-5140-9154, Huyuk, Tayfun -- 0000-0003-0597-9767, Ince, Elif -- 0000-0003-4821-5441, Algora, Alejandro -- 0000-0002-5199-1794, Calore, Enrico -- 0000-0002-2301-3838, Rubio, Berta -- 0000-0002-9149-4151, THEISEN, Christophe -- 0000-0002-8509-1022, Rudolph, Dirk -- 0000-0003-1199-3055, Gadea, Andres -- 0000-0002-4233-1970, santos, cayetano -- 0000-0003-0727-1914, nannini, adriana -- 0000-0003-0659-7648, Depalo, Rosanna -- 0000-0003-3943-7982, Suliman, gabriel -- 0000-0001-8475-1992, Blasco, Jose-Maria -- 0000-0002-7663-9092, Petrache, Costel -- 0000-0001-8419-1390, Pietralla, Norbert -- 0000-0002-4797-3032, Cederwall, Bo -- 0000-0003-1771-2656, Zucchiatti, Alessandro -- 0000-0002-3647-596X, Mendez Munoz, Victor -- 0000-0002-9044-1189, Kruecken, Reiner -- 0000-0002-2755-8042, Napoli, Daniel Ricardo -- 0000-0002-8154-6958, Tain, Jose L. -- 0000-0002-3263-6965, SANCHIS, ENRIQUE -- 0000-0002-9689-9131, Zieblinski, Miroslaw -- 0000-0002-8693-7317, Hauschild, Karl -- 0000-0003-2862-2445, Montanari, Daniele -- 0000-0002-1980-7686, senyigit, menekse -- 0000-0002-2408-4419, La Rana, Giovanni -- 0000-0003-2814-4113, Menegazzo, Roberto -- 0000-0002-3060-5276, Soderstrom, Par-Anders -- 0000-0002-9504-2814, Unsworth, Carl -- 0000-0002-4100-7466, Camera, Franco -- 0000-0003-1731-4834, Gorgen, Andreas -- 0000-0003-1916-9941, Hernandez Prieto, Alvaro -- 0000-0002-0340-0240, Recchia, Francesco -- 0000-0002-8428-0112, de France, Gilles -- 0000-0002-7439-1759, GOTTARDO, Andrea -- 0000-0002-0390-5767, Perrier, Sebastien -- 0000-0001-5055-9046, Sowicki, Bogdan -- 0000-0002-7208-0690, Robinson, Andrew -- 0000-0002-2510-1321, Sahin, Eda -- 0000-0003-0683-5140, Pullia, Alberto -- 0000-0002-6393-747X, Lelli, Francesco -- 0000-0003-1900-9171, Clement, Emmanuel -- 0000-0003-1887-717X, benzoni, giovanna -- 0000-0002-7938-0338, Jonson, Bjorn -- 0000-0002-9697-9115, Bednarczyk, Piotr -- 0000-0002-5699-5292, Jones, Pete -- 0000-0001-7480-6603, Nicoletto, Marino -- 0000-0001-9301-0782, Ripamonti, Giancarlo -- 0000-0002-9406-021X, Bentley, Michael -- 0000-0001-8401-3455, Pellegri, Luna -- 0000-0002-3227-3332, Barrientos, Diego -- 0000-0001-9693-2942, GIAZ, Agnese -- 0000-0002-2550-450X, [Boston, A. J. -- Boston, H. C. -- Colosimo, S. -- Cooper, R. J. -- Cresswell, J. R. -- Dimmock, M. R. -- Filmer, F. -- Grint, A. N. -- Harkness, L. J. -- Judson, D. S. -- Mather, A. R. -- Moon, S. -- Nelson, L. -- Nolan, P. J. -- Norman, M. -- Oxley, D. C. -- Rigby, S. -- Sampson, J. -- Scraggs, D. P. -- Seddon, D. -- Slee, M. -- Stanios, T. -- Thornhill, J. -- Unsworth, C. -- Wells, D.] Univ Liverpool, Oliver Lodge Lab, Liverpool L69 7ZE, Merseyside, England -- [Akkoyun, S. -- Atac, A. -- Kaskas, A. -- Senyigit, M.] Ankara Univ, Fac Sci, Dept Phys, TR-06100 Ankara, Turkey -- [Algora, A. -- Barrientos, D. -- Domingo-Pardo, C. -- Egea, J. -- Gadea, A. -- Hueyuek, T. -- Kaci, M. -- Mendez, V. -- Rubio, B. -- Salt, J. -- Tain, J. L.] Univ Valencia, CSIC, IFIC, E-46980 Paterna, Spain -- [Alikhani, B. -- Boutachkov, P. -- Givechev, A. -- Goel, N. -- Leske, J. -- Merchan, E. -- Moeller, O. -- Pietralla, N. -- Reese, M. -- Stahl, C.] Tech Univ Darmstadt, IKP, D-64289 Darmstadt, Germany -- [Ameil, F. -- Beck, T. -- Boutachkov, P. -- Domingo-Pardo, C. -- Engert, T. -- Gerl, J. -- Goel, N. -- Habermann, T. -- Kojouharov, I. -- Kurz, N. -- Merchan, E. -- Pietri, S. -- Schaffner, H. -- Tashenov, S. -- Wollersheim, H. J.] GSI Helmholtzzentrum Schwerionenforsch GmbH, D-64291 Darmstadt, Germany -- [de Angelis, G. -- Badoer, S. -- Berti, L. -- Calore, E. -- Cocconi, P. -- Conventi, D. -- Costa, L. -- Fantinel, S. -- Gadea, A. -- Gottardo, A. -- Gulmini, M. -- He, C. -- Ince, E. -- Kroell, Th. -- Lelli, F. -- Maron, G. -- Molini, P. -- Napoli, D. R. -- Rigato, M. -- Rosso, D. -- Sahin, E. -- Spolaore, P. -- Toniolo, N. -- Valiente-Dobon, J. J.] Ist Nazl Fis Nucl, Lab Nazl Legnaro, IT-35020 Padua, Italy -- [Arnold, L. -- Baumann, R. -- Beck, F. A. -- El Chambit, M. -- Charles, L. -- Curien, D. -- Didierjean, F. -- Duchene, G. -- Faul, T. -- Filliger, M. -- Finck, Ch. -- Medina, P. -- Pachoud, E. -- Parisel, C. -- Piqueras, I. -- Richer, M. -- Robin, J. -- Santos, C. -- Sigward, M. -H. -- Weber, C.] Univ Strasbourg, IPHC, F-67037 Strasbourg, France -- [Arnold, L. -- Baumann, R. -- Beck, F. A. -- El Chambit, M. -- Charles, L. -- Curien, D. -- Didierjean, F. -- Duchene, G. -- Faul, T. -- Filliger, M. -- Finck, Ch. -- Medina, P. -- Pachoud, E. -- Parisel, C. -- Piqueras, I. -- Richer, M. -- Robin, J. -- Santos, C. -- Sigward, M. -H. -- Weber, C.] CNRS, UMR 7178, F-67037 Strasbourg, France -- [Astier, A. -- Cabaret, S. -- Desesquelles, P. -- Dosme, N. -- Gibelin, L. -- Ha, H. T. M. -- Hauschild, K. -- Karkour, N. -- Korichi, A. -- Lafay, X. -- Leboutelier, S. -- Legay, E. -- Lhenoret, S. -- Linget, D. -- Ljungvall, J. -- Lopez-Martens, A. -- Morbiducci, F. -- Ngo, V. L. -- Pariset, P. -- Perrier, S. -- Pierre, E. -- Roccaz, J. -- Travers, B.] Univ Paris 11, CNRS, IN2P3, CSNSM, F-91405 Orsay, France -- [Atac, A. -- Nyberg, J. -- Soderstrom, P. -A.] Uppsala Univ, Dept Phys & Astron, Uppsala, Sweden -- [Atac, A. -- Cederwall, B. -- Johnson, A. -- Khaplanov, A. -- van der Marel, J. -- Milechina, L. -- Tashenov, S.] Royal Inst Technol, SE-10691 Stockholm, Sweden -- [Aubert, Y. -- Azaiez, F. -- Le Blanc, F. -- Cercus, J. -L. -- Chambert, V. -- Commeaux, C. -- Delbourg, D. -- Diarra, C. -- Dorangeville, F. -- Edelbruck, P. -- Grave, X. -- Guevara, L. -- Harroch, H. -- Ky, B. Y. -- Lavergne, L. -- Lefebvre, F. -- Lermitage, A. -- Olariu, A. -- Oziol, C. -- Petrache, C. -- Pouthas, J. -- Salomon, F. -- Tanguy, S. -- Tun-Lanoe, K. M. M.] Univ Paris 11, CNRS, IN2P3, IPNO, F-91406 Orsay, France -- [Aufranc, C. -- Baulieu, G. -- Doan, Q. T. -- Pugnere, D. -- Redon, N. -- Rosse, B. -- Stezowski, O.] Univ Lyon 1, CNRS, IN2P3, Inst Phys Nucl Lyon, F-69622 Villeurbanne, France -- [Austin, A. -- Burrows, I. -- Coleman-Smith, P. J. -- Griffiths, R. -- Kogimtzis, M. -- Labiche, M. -- Lazarus, I. H. -- Letts, S. C. -- Morrall, P. S. -- Palin, J. -- Pucknell, V. F. E. -- Simpson, J. -- Strachan, J.] STFC Daresbury Lab, Warrington WA4 4AD, Cheshire, England -- [Aydin, S. -- Bazzacco, D. -- Bellato, M. -- Bortolato, D. -- Chavas, J. -- Colombo, A. -- Fanin, C. -- Farnea, E. -- Isocrate, R. -- Kroell, Th. -- Lenzi, S. M. -- Lunardi, S. -- Marginean, R. -- Menegazzo, R. -- Mengoni, D. -- Michelagnoli, C. -- Nespolo, M. -- Nicoletto, M. -- Peghin, R. -- Ramina, L. -- Rampazzo, G. -- Rebeschini, M. -- Recchia, F. -- Rossi Alvarez, C. -- Salvato, G. -- Triossi, A. -- Turcato, M. -- Ur, C. A. -- Venturelli, R. -- Veronese, F.] Ist Nazl Fis Nucl, Sez Padova, IT-35131 Padua, Italy -- [Balabanski, D. L. -- Detistov, P. -- Petkov, P. -- Stefanova, E.] Bulgarian Acad Sci, Inst Nucl Res & Nucl Energy, Sofia, Bulgaria -- [Bednarczyk, P. -- Czermak, A. -- Dulny, B. -- Grebosz, J. -- Maj, A. -- Meczynski, W. -- Sowicki, B. -- Zieblinski, M.] Polish Acad Sci, Henryk Niewodniczanski Inst Nucl Phys, PL-31342 Krakow, Poland -- [Bentley, M. A. -- Bloor, D. -- Joshi, P. -- Wadsworth, R.] Univ York, Dept Phys, York YO10 5DD, N Yorkshire, England -- [Benzoni, G. -- Blasi, N. -- Boiano, C. -- Bracco, A. -- Brambilla, S. -- Camera, F. -- Capsoni, A. -- Casati, G. -- Coelli, S. -- Corsi, A. -- Cortesi, A. -- Crespi, F. C. L. -- Geraci, A. -- Giaz, A. -- Leoni, S. -- Million, B. -- Montanari, D. -- Nicolini, R. -- Pellegri, L. -- Pignanelli, M. -- Pullia, A. -- Riboldi, S. -- Ripamonti, G. -- Tomasi, F. -- Vandone, V. -- Viscione, E. -- Wieland, O. -- Zocca, F.] Ist Nazl Fis Nucl, Sez Milano, IT-20133 Milan, Italy -- [Berthier, R. -- Bouty, A. -- Broussard, S. -- Buerger, A. -- Drouen, Y. -- Gros, P. -- Goergen, A. -- Hervieu, B. -- Karolak, M. -- Kebbiri, M. -- Korten, W. -- Ljungvall, J. -- Lotode, A. -- Mariette, Y. -- Le Noa, Y. -- Obertelli, A. -- Le Pouhalec, P. -- Salsac, M. -D. -- Theisen, Ch. -- Touzery, R. -- Veyssiere, Ch.] CEA, Ctr Saclay, IRFU, F-91191 Gif Sur Yvette, France -- [Beunard, R. -- Bourgault, P. -- Cahan, B. -- Clement, E. -- de France, G. -- Legeard, L. -- Ozille, M. -- Pancin, J. -- Raine, R. -- Ropert, J. -A. -- Saillant, F. -- Tripon, M. -- Wittwer, G.] CEA DSM CNRS IN2P3, GANIL, F-14076 Caen, France -- [Birkenbach, B. -- Bruyneel, B. -- Eberth, J. -- Hess, H. -- Jolie, J. -- Lersch, D. -- Pascovici, G. -- Reiter, P. -- Warr, N. -- Weisshaar, D. -- Wiens, A.] Univ Cologne, IKP, D-50937 Cologne, Germany -- [Bizzeti, P. G. -- Bizzeti-Sona, A. M. -- Giannatiempo, A. -- Melon, B. -- Perego, A. -- Sona, P.] Univ Florence, Dipartimento Fis & Astron, IT-50019 Florence, Italy -- [Bizzeti, P. G. -- Bizzeti-Sona, A. M. -- Giannatiempo, A. -- Melon, B. -- Nannini, A. -- Perego, A. -- Sona, P.] Ist Nazl Fis Nucl, Sez Firenze, IT-50019 Florence, Italy -- [Blasco, J. M. -- Carrio, F. -- Egea, J. -- Gonzalez, V. -- Sanchis, E.] Univ Valencia, Dept Elect Engn, E-46100 Burjassot, Valencia, Spain -- [Borsato, M. -- Bortolato, D. -- Lenzi, S. M. -- Lunardi, S. -- Marginean, R. -- Mengoni, D. -- Michelagnoli, C. -- Nespolo, M. -- Recchia, F. -- Salvato, G. -- Triossi, A. -- Venturelli, R.] Univ Padua, Dipartimento Fis, IT-35131 Padua, Italy -- [Bracco, A. -- Camera, F. -- Corsi, A. -- Crespi, F. C. L. -- Giaz, A. -- Leoni, S. -- Montanari, D. -- Nicolini, R. -- Pellegri, L. -- Pignanelli, M. -- Pullia, A. -- Riboldi, S. -- Vandone, V.] Univ Milan, Dipartimento Fis, IT-20133 Milan, Italy -- [Brawn, I. P.] STFC Rutherford Appleton Lab, Didcot OX11 0QX, Oxon, England -- [Brondi, A. -- Moro, R. -- La Rana, G. -- Vardaci, E.] Univ Naples Federico II, Dipartimento Fis, IT-80126 Naples, Italy -- [Brondi, A. -- Moro, R. -- La Rana, G. -- Vardaci, E.] Ist Nazl Fis Nucl, Sez Napoli, IT-80126 Naples, Italy -- [Bucurescu, D. -- Marginean, N. -- Marginean, R. -- Petcu, M. -- Ur, C. A.] Natl Inst Phys & Nucl Engn, Bucharest, Romania -- [Buerger, A. -- Suliman, G. -- Zamfir, N. V.] Univ Bonn, Helmholtz Inst Strahlen & Kernphys, D-53115 Bonn, Germany -- [Buerger, A.] Univ Oslo, Dept Phys, N-0316 Oslo, Norway -- [Casati, G. -- Geraci, A. -- Ripamonti, G.] Politecn Milan, Dipartimento Elettron & Informaz, IT-20133 Milan, Italy -- [Castoldi, M. -- Zucchiatti, A.] Ist Nazl Fis Nucl, Sez Genova, IT-16146 Genoa, Italy -- [Chapman, R. -- Mengoni, D. -- Orlandi, R. -- Smith, J. F.] Univ W Scotland, Sch Engn, Paisley PA1 2BE, Renfrew, Scotland -- [Cullen, D. M. -- Robinson, A. P.] Univ Manchester, Sch Phys & Astron, Schuster Lab, Manchester M13 9PL, Lancs, England -- [Depalo, R.] Univ Padua, Dipartimento Astron, IT-35131 Padua, Italy -- [Descombes, T. -- Simpson, G.] Univ Grenoble 1, CNRS, IN2P3, LPSC,INP Grenoble, F-38026 Grenoble, France -- [Doncel, M. -- Hernandez-Prieto, A. -- Quintana, B.] Univ Salamanca, Dept Fis Fundamental, E-37008 Salamanca, Spain -- [Erduran, M. N. -- Ince, E.] Istanbul Univ, Istanbul, Turkey -- [Erturk, S.] Nigde Univ, Fac Sci, Dept Phys, TR-51200 Nigde, Turkey -- [Gast, W. -- Lieder, R. M. -- Mihailescu, L.] Forschungszentrum Julich, Inst Kernphys, D-52425 Julich, Germany -- [Gernhaeuser, R. -- Klupp, S. -- Kruecken, R. -- Schlarb, M.] Tech Univ Munich, Phys Dept E12, D-85748 Garching, Germany -- [Jaworski, G.] Warsaw Univ Technol, Fac Phys, PL-00662 Warsaw, Poland -- [Jaworski, G. -- Mierzejewski, J. -- Palacz, M.] Univ Warsaw, Heavy Ion Lab, PL-02093 Warsaw, Poland -- [Jones, P.] Univ Jyvaskyla, Dept Phys, FI-40014 Jyvaskyla, Finland -- [Jonson, B.] Chalmers, S-41296 Gothenburg, Sweden -- [Jungclaus, A. -- Orlandi, R.] CSIC, Inst Estruct Mat, E-28006 Madrid, Spain -- [Kempley, R. S. -- Podolyak, Z. -- Regan, P. H. -- Walker, P. M.] Univ Surrey, Dept Phys, Guildford GU2 7XH, Surrey, England -- [Mitev, K. -- Rainovski, G.] Sofia Univ St Kliment Ohridski, Fac Phys, Sofia, Bulgaria -- [Ozben, C.] Istanbul Tech Univ, TR-80626 Istanbul, Turkey -- [Rudolph, D.] Lund Univ, Dept Phys, SE-22100 Lund, Sweden, Research Group: Information Management, CSNSM SNO, Centre de Spectrométrie Nucléaire et de Spectrométrie de Masse (CSNSM), Université Paris-Sud - Paris 11 (UP11)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Université Paris-Sud - Paris 11 (UP11)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Centre de Sciences Nucléaires et de Sciences de la Matière (CSNSM), Université Paris-Sud - Paris 11 (UP11)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), Institut de Physique Nucléaire d'Orsay (IPNO), informatique, Institut de Physique Nucléaire de Lyon (IPNL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), Institut Pluridisciplinaire Hubert Curien (IPHC), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), Grand Accélérateur National d'Ions Lourds (GANIL), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), Département de Physique Nucléaire (ex SPhN) (DPHN), Institut de Recherches sur les lois Fondamentales de l'Univers (IRFU), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, CSNSM MECA, Université Paris-Sud - Paris 11 (UP11)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Université Paris-Sud - Paris 11 (UP11)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Physique Subatomique et de Cosmologie (LPSC), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Institut Polytechnique de Grenoble - Grenoble Institute of Technology-Centre National de la Recherche Scientifique (CNRS), CSNSM INFOR, CSNSM ELEC, Matière Nucléaire, Institut de Physique des 2 Infinis de Lyon (IP2I Lyon), AGATA, Akkoyun, S., Algora, A., Alikhani, B., Ameil, F., De Angelis, G, Arnold, L., Astier, A., Ataç, A., Aubert, Y., Aufranc, C., Austin, A., Aydin, S., Azaiez, F., Badoer, S., Balabanski, D. L., Barrientos, D., Baulieu G., L, Baumann, R., Bazzacco, D., Beck, F. A., Beck, T., Bednarczyk, P., Bellato, M., Bentley, M. A., Benzoni, G., Berthier, R., Berti, L., Beunard, R., Lo Bianco, G., Birkenbach, B., Bizzeti, P. G., Bizzeti Sona, A. M., Le Blanc, F., Blasco, J. M., Blasi, N., Bloor, D., Boiano, C., Borsato, M., Bortolato, D., Boston, A. J., Boston, H. C., Bourgault, P., Boutachkov, P., Bouty, A., Bracco, A., Brambilla, S., Brawn, I. P., Brondi, Augusto, Broussard, S., Bruyneel, B., Bucurescu, D., Burrows, I., Bürger, A., Cabaret, S., Cahan, B., Calore, E., Camera, F., Capsoni, A., Carrió, F., Casati, G., Castoldi, M., Cederwall, B., Cercus J., L, Chambert, V., El Chambit, M., Chapman, R., Charles, L., Chavas, J., Clément, E., Cocconi, P., Coelli, S., Coleman Smith, P. J., Colombo, A., Colosimo, S., Commeaux, C., Conventi, D., Cooper, R. J., Corsi, A., Cortesi, A., Costa, L., Crespi, F. C. L., Cresswell, J. R., Cullen, D. M., Curien, D., Czermak, A., Delbourg, D., Depalo, R., Descombes, T., Désesquelles, P., Detistov, P., Diarra, C., Didierjean, F., Dimmock, M. R., Doan, Q. T., Domingo Pardo, C., Doncel, M., Dorangeville, F., Dosme, N., Drouen, Y., Duchêne, G., Dulny, B., Eberth, J., Edelbruck, P., Egea, J., Engert, T., Erduran, M. N., Ertürk, S., Fanin, C., Fantinel, S., Farnea, E., Faul, T., Filliger, M., Filmer, F., Finck, C., De France, G., Gadea, A., Gast, W., Geraci, A., Gerl, J., Gernhäuser, R., Giannatiempo, A., Giaz, A., Gibelin, L., Givechev, A., Goel, N., González, V., Gottardo, A., Grave, X., Grȩbosz, J., Griffiths, R., Grint, A. N., Gros, P., Guevara, L., Gulmini, M., Görgen, A., Ha, H. T. M., Habermann, T., Harkness, L. J., Harroch, H., Hauschild, K., He, C., Hernández Prieto, A., Hervieu, B., Hess, H., Hüyük, T., Ince, E., Isocrate, R., Jaworski, G., Johnson, A., Jolie, J., Jones, P., Jonson, B., Joshi, P., Judson, D. S., Jungclaus, A., Kaci, M., Karkour, N., Karolak, M., Kaşkaş, A., Kebbiri, M., Kempley, R. S., Khaplanov, A., Klupp, S., Kogimtzis, M., Kojouharov, I., Korichi, A., Korten, W., Kröll, T., Krücken, R., Kurz, N., Ky, B. Y., Labiche, M., Lafay, X., Lavergne, L., Lazarus, I. H., Leboutelier, S., Lefebvre, F., Legay, E., Legeard, L., Lelli, F., Lenzi, S. M., Leoni, S., Lermitage, A., Lersch, D., Leske, J., Letts, S. C., Lhenoret, S., Lieder, R. M., Linget, D., Ljungvall, J., Lopez Martens, A., Lotodé, A., Lunardi, S., Maj, A., Van Der Marel, J., Mariette, Y., Marginean, N., Marginean, R., Maron, G., Mather, A. R., Mȩczyński, W., Mendéz, V., Medina, P., Melon, B., Menegazzo, R., Mengoni, D., Merchan, E., Mihailescu, L., Michelagnoli, C., Mierzejewski, J., Milechina, L., Million, B., Mitev, K., Molini, P., Montanari, D., Moon, S., Morbiducci, F., Moro, RENATA EMILIA MARIA, Morrall, P. S., Möller, O., Nannini, A, Napoli, D. R., Nelson, L., Nespolo, M., Ngo, V. L., Nicoletto, M., Nicolini, R., Le Noa, Y., Nolan, P. J., Norman, M., Nyberg, J., Obertelli, A., Olariu, A., Orlandi, R., Oxley, D. C., Özben, C., Ozille, M., Oziol, C., Pachoud, E., Palacz, M., Palin, J., Pancin, J., Parisel, C., Pariset, P., Pascovici, G., Peghin, R., Pellegri, L., Perego, A., Perrier, S., Petcu, M., Petkov, P., Petrache, C., Pierre, E., Pietralla, N., Pietri, S., Pignanelli, M., Piqueras, I., Podolyak, Z., Le Pouhalec, P., Pouthas, J., Pugnére D., L, Pucknell, V. F. E., Pullia, A., Quintana, B., Raine, R., Rainovski, G., Ramina, L., Rampazzo, G., LA RANA, Giovanni, Rebeschini, M., Recchia, F., Redon N., L, Reese M., C, Reiter, P., Regan, P. H., Riboldi, S., Richer, M., Rigato, M., Rigby, S., Ripamonti, G., Robinson, A., Robin, J., Roccaz, J., Ropert, J. A., Rossé, B. l., Rossi Alvarez, C., Rosso, D., Rubio, B., Rudolph, D., Saillant, F., Şahin, E., Salomon, F., Salsac, M. 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V., Ziȩbliński, M., Zucchiatti, A., Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Paris-Sud - Paris 11 (UP11)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Paris-Sud - Paris 11 (UP11)-Centre de Sciences Nucléaires et de Sciences de la Matière (CSNSM), Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Paris-Sud - Paris 11 (UP11), Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3), Université de Strasbourg (UNISTRA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3), Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Paris-Sud - Paris 11 (UP11)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Paris-Sud - Paris 11 (UP11), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut Polytechnique de Grenoble - Grenoble Institute of Technology-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Joseph Fourier - Grenoble 1 (UJF)-Centre National de la Recherche Scientifique (CNRS), Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), and 0-Belirlenecek

Subjects
Nuclear and High Energy Physics, Physics - Instrumentation and Detectors, Pulse-shape and gamma-ray tracking algorithms, FOS: Physical sciences, Semiconductor detector performance and simulations, Integrated circuit, [PHYS.NEXP]Physics [physics]/Nuclear Experiment [nucl-ex], Tracking (particle physics), gamma-Ray tracking, 01 natural sciences, Pulse-shape and γ-ray tracking algorithms, law.invention, Data acquisition, law, 0103 physical sciences, ddc:530, [PHYS.PHYS.PHYS-INS-DET]Physics [physics]/Physics [physics]/Instrumentation and Detectors [physics.ins-det], Nuclear Experiment (nucl-ex), 010306 general physics, γ-Ray spectroscopy, Nuclear Experiment, Instrumentation, Digital signal processing, Event reconstruction, gamma-Ray spectroscopy, Physics, sezele, Spectrometer, Spectrometers, 010308 nuclear & particles physics, business.industry, Detector, AGATA, Digital signals, HPGe detectors, Pulse-shape, Ray tracking, HPGe detectors, Algorithms, Crystals, Germanium, Semiconductor detectors, Signal processing, Spectrometry, Tracking (position), γ-Ray tracking, Instrumentation and Detectors (physics.ins-det), AGATA, Física nuclear, business, Computer hardware
Abstract

WOS: 000300864200005, The Advanced GAmma Tracking Array (AGATA) is a European project to develop and operate the next generation gamma-ray spectrometer. AGATA is based on the technique of gamma-ray energy tracking in electrically segmented high-purity germanium crystals. This technique requires the accurate determination of the energy, time and position of every interaction as a gamma ray deposits its energy within the detector volume. Reconstruction of the full interaction path results in a detector with very high efficiency and excellent spectral response. The realisation of gamma-ray tracking and AGATA is a result of many technical advances. These include the development of encapsulated highly segmented germanium detectors assembled in a triple cluster detector cryostat, an electronics system with fast digital sampling and a data acquisition system to process the data at a high rate. The full characterisation of the crystals was measured and compared with detector-response simulations. This enabled pulse-shape analysis algorithms, to extract energy, time and position, to be employed. In addition, tracking algorithms for event reconstruction were developed. The first phase of AGATA is now complete and operational in its first physics campaign. In the future AGATA will be moved between laboratories in Europe and operated in a series of campaigns to take advantage of the different beams and facilities available to maximise its science output. The paper reviews all the achievements made in the AGATA project including all the necessary infrastructure to operate and support the spectrometer. (C) 2011 Elsevier B.V. All rights reserved., EU [RII3-CT-2004-506065]; German BMBF [06K-167, 06KY2051]; Swedish Research Council; Knut and Alice Wallenberg Foundation; UK EPSRC Engineering and Physical Sciences Research Council; UK STFC Science and Technology Facilities Council; AWE plc; Scientific and Technological Research Council of Turkey [106T055]; Ankara University [05B4240002]; Polish Ministry of Science and Higher Education [DPN/N190/AGATA/2009]; Spanish MICINN [FPA2008-06419, FPA2009-13377-C02-02]; Spanish Consolider-Ingenio Programme CPAN [CSD2007-00042]; Generalitat Valenciana [PROMETEO/2010/101]; MICINN, Spain; INFN, Italy [AIC10-D-000568]; Science and Technology Facilities Council [ST/F012039/1, ST/J000094/1, ST/F004192/1, ST/J000159/1, ST/I504940/1, NuSTAR, ST/F006950/1, ST/I504916/1, ST/G000670/1, ST/F004060/1, ST/J000051/1, ST/J000108/1, ST/G000670/1 NuSTAR, ST/I504959/1, ST/G000727/1, ST/F004052/1, ST/F004184/1], AGATA and this work is supported by the European funding bodies and the EU Contract RII3-CT-2004-506065, the German BMBF under Grants 06K-167 and 06KY2051, the Swedish Research Council and the Knut and Alice Wallenberg Foundation, UK EPSRC Engineering and Physical Sciences Research Council, UK STFC Science and Technology Facilities Council, AWE plc, Scientific and Technological Research Council of Turkey (Proj. nr. 106T055) and Ankara University (BAP Proj. nr. 05B4240002), the Polish Ministry of Science and Higher Education under Grant DPN/N190/AGATA/2009, the Spanish MICINN under grants FPA2008-06419 and FPA2009-13377-C02-02, the Spanish Consolider-Ingenio 2010 Programme CPAN (contract number CSD2007-00042) the Generalitat Valenciana under Grant PROMETEO/2010/101, and research performed in the frame of the GSI-IN2P3 collaboration agreement number 02-42. A. Gadea and E. Farnea acknowledge the support of MICINN, Spain, and INFN, Italy, through the AIC10-D-000568 bilateral action.

Published
2012
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